Active Middle Ear Implantation for Patients With Sensorineural Hearing Loss and External Otitis: Long-Term Outcome in Patient Satisfaction Joost W. Zwartenkot, Javad Hashemi, Cor W. R. J. Cremers, Jef J. S. Mulder, and Ad F. M. Snik Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of OtorhinolaryngologyYHead and Neck Surgery, Nijmegen, The Netherlands Objective: To study long-term subjective benefit of patients with sensorineural hearing loss and chronic external otitis who use active middle ear implants. Design: Single-subject repeated measures in a preintervention and postintervention design with multiple postintervention mea- surements (questionnaires). Setting: Tertiary academic center. Patients: Moderate-to-severe sensorineural hearing loss (n = 56) with severe chronic external otitis who use the Vibrant Sound- bridge (VSB) or Otologics MET middle ear implant systems. Main Outcome Measure: Changes in hearing disability and handicap as evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB), the Nijmegen Cochlear Implant Ques- tionnaire (NCIQ), and the Glasgow Benefit Inventory (GBI). Results: Data of 33 patients (mean postoperative duration of 7.5 yr) were available. No difference in subjective results was found between the VSB and Otologics MET patient groups. Total percentage of nonuse was 13%. Long-term APHAB results show a significant decrease in disability for 43% of the patients compared with 54% at 1-year postoperative. NCIQ results show a significant benefit for all subdomains with a negative trend over time. The GBI results show a significant long-term increase in quality of life with positive scores for 82% of the assessed patients. Conclusion: Long-term postoperative patient satisfaction and quality of life results show a significant difference compared with preoperative measurements, with conventional hearing aids. A negative trend over time is found on all questionnaires, which might reflect patient aging (increase of hearing loss) or habit- uation to a situation with fewer concerns regarding a patient’s external otitis. Key Words: Abbreviated Profile of Hearing Aid BenefitVActive middle ear implantsVGlasgow Benefit InventoryVNijmegen Cochlear Implant QuestionnaireVOtologics METVQuality of lifeVSubjective benefitVVibrant Soundbridge. Otol Neurotol 34:855Y861, 2013. Some patients with hearing loss decline to use acoustic hearing aids because of cosmetic reasons or complaints about poor sound quality (1Y3). For other patients, appli- cation of acoustic devices might be troublesome because of therapy-resistant chronic external otitis. Although ven- tilated or specially coated ear moulds might be beneficial for the latter patient group, many patients cease to use the hearing device because of pain or itching (4). For such patients, an active middle ear implant (AMEI) has been advocated. An AMEI comprises an externally worn audio proces- sor and an implanted signal processor and output trans- ducer. The transducer is a specially developed implantable magnetic actuator that is in contact with the middle ear ossicles. The audio processor is magnetically connected to the implant and communicates with it through the skin by means of radiofrequency signals. AMEI are generally be- lieved to be more attractive from a cosmetic point of view as the audioprocessor is easily hidden by hair. Further- more, better sound quality has been claimed over conven- tional hearing aids (1Y3), and as the device bypasses the external ear canal, it might be the solution for patients with chronic external otitis (5). In 1996, we started implanting the semi-implantable Otologics MET (MET) device (Otologics LLC, Boulder, CO, USA) and the Vibrant Soundbridge (VSB) mid- dle ear implant (Med-El, Innsbruck, Austria) in patients with sensorineural hearing loss who also had severe, therapy-resistant external otitis, thereby avoiding the use of ear moulds. Address correspondence and reprint requests to Joost W. Zwartenkot, M.D., Department of OtorhinolaryngologyYHead and Neck Surgery, Radboud University, Nijmegen Medical Center, P.O. Box 9101 6500 HB Nijmegen, The Netherlands; E-mail: j.zwartenkot@kno.umcn.nl The authors disclose no conflicts of interest. Otology & Neurotology 34:855Y861 Ó 2013, Otology & Neurotology, Inc. 855 Copyright © 2013 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.